Sphincter First HoLEP: A New Technique to Improve Continence

Abstract

Introduction: Transurethral enucleation of the prostate has proven to be a safe, effective, and durable technique in treating benign prostatic hyperplasia. Despite this, rates of postoperative stress urinary incontinence (SUI) are still an issue. We have been using en bloc enucleation for the past 4 years and, after mastering this technique, we developed an enucleation technique that, upon initially releasing the external sphincter, avoids the lesion caused by stretching and keeps the sphincteric mucosa intact. Our objective is to evaluate the safety, feasibility, and effect in SUI of a new surgical technique: sphincter first HoLEP (sf-HoLEP). Materials and Methods: sf-HoLEP was performed in 50 subjects by a single surgeon. Demographic and clinical data were collected. The annexed video shows the enucleation technique in detail. Results: Mean age was 72.8 years. Preoperative mean international prostatic symptoms score (IPSS) was 23.3. Preoperative mean peak flow and postvoid volume were 8.4 mL/s and 129.8 mL, respectively. Preoperative mean prostatic specific antigen was 6.1 ng/mL. Mean preoperative prostate volume was 95.8 cc (range 40–170 cc). sf-HoLEP was performed in the 50 subjects. The mean resected tissue was 68.8 g. No major complications were reported. Immediate continence was achieved in 48% of patients. At 1 and 6 months, the rate of reported stress incontinence was 4% and 2%. Compared with preoperative, IPSS scores, quality of life score, peak flow, and postvoid volume showed significative improvement at 6 months. Conclusion: sf-HoLEP is an innovative, feasible, and safe technique. sf-HoLEP seems to improve continence rates. Patient Consent Statement: Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure. We declare that all authors have no conflicts of interest. Runtime of video: 9 mins 00 secs